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HL7 FHIR Training course
Ewout Kramer
March 2014
Name (SSID):Password:
Updated for
FHIR DSTU!
© 2012 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Who am I?
Name: Ewout Kramer Company: Furore, Amsterdam Background:
FHIR core team, RIMBAA Software developer & healthcare
architect Contact:
[email protected] www.thefhirplace.com
© 2012 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Introduce ourselves
About your organization… HL7 (v2/v3) background? How did you hear about FHIR? Platform of choice (.NET, Java, Ruby, …)? Familiar with HTTP, Xml, JSON, REST? Persistence technologies used?
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Morning program
Introduction to FHIR the Resource and REST Exercise #1 Deconstructing the FHIR data model Exercise #2
LUNCH
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INTRODUCTION TO FHIR
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Fast Relative – No technology can make integration as fast as we’d like
HealthcareInteroperabilityThat’s why we’re here
ResourcesBuilding blocks – more on these to follow
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“How can I get data from my server to my iOS app?”
“How do I connect my applications using cloud storage?”
“How can I give record-based standardized access to my PHR?”
The Need
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Highrise
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FHIR Manifesto
Focus on implementers Keep common scenarios simple Leverage existing technologies Provide human readability Make content freely available Demonstrate best practice governance
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Implementer Focus
Specification is written for one target audience: implementers Rationale, modeling approaches, etc. kept elsewhere
Multiple reference implementations from day 1 Publicly available test servers Starter APIs published with spec
Delphi, C#, Java – more to come Connectathons to verify specification approaches Instances you can read and understand Lots of examples (and they’re valid too)
using HL7.Fhir.Instance.Model;using HL7.Fhir.Instance.Parsers;using HL7.Fhir.Instance.Support;
XmlReader xr = XmlReader.Create(
new StreamReadIFhirReader r = new XmlFhirReader
// JsonTextReader jr = new JsonTe// new StreamRead// IFhirReader r = new JsonFhirRe
ErrorList errors = new ErrorList(LabReport rep = (LabReport)ResourAssert.IsTrue(errors.Count() == 0
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WHAT’S IN THE BOX?
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Patient Prescription
Resources
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13
Cover all usecases - (n)ever
HL7v3 RIM
Generic
HL7 CDA
C-CCD
openEHR RM
HL7v2
IHE PDQ
FHIR
Specific
openEHR Archetypes
openEHR Templates
HL7v3 CMETS
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The 80/20 rule
Design for the 80%, not 100% Only include data elements in the artifacts if 80%
of all implementers of that artifact will use the data element
Allow easy extension for the remaining 20% of elements which often make up 80% of current specs Vocabulary approach to extension definition
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Kinds of Resources
Administrative Concepts Patient, Organization, Device, Location
Clinical Concepts Allergy, Condition, Medication, Family History Care Plan
Infrastructure Functionality Document, Message, Conformance/Profiling
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+ =
Extensibility
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The Case for Extensions
Simple choice – design for absolutely everything or allow extensions
Everyone needs extensions, everyone hates them
Define, publish, find extensions Repository Documented just like resources Can be fetched & interpreted by clients
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Message
Document
REST
HTTP/1.1 200 OKContent-Type: application/json;charset=utf-8Content-Length: 627Content-Location: /fhir/person/@1/history/@1Last-Modified: Tue, 29 May 2012 23:45:32 GMTETag: "1“
"Person":{"id":{"value":"1"},"identifier":[{"type":{"code":"ssn","system":"http://hl7.org/fhir/sid
Transport
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Just follow the industry...
Exchanges use XML & JSON Collections represented using ATOM
Same technology that gives you your daily news summary
Out-of-the-box publish/subscribe Support for REST: Web calls work the same
way they do for Facebook & Twitter Rely on HTTPS, OAuth, etc. for security
functions
http://...
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Paradigms
FHIR supports 4 interoperability paradigms
REST Documents
Messages Services
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Cross-paradigms
Regardless of paradigm the content is the same This means it’s straight-forward to share content
across paradigms E.g. Receive a lab result in a message. Package
it in a discharge summary document It also means constraints can be shared across
paradigms E.g. Define a profile for Blood Pressure and use it
on resources in messages, documents, REST and services
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DESIGN OF THE RESOURCE
Looking at FHIR Resources from a software engineering perspective
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Resources
“Resources” are: Small logically discrete units of exchange Defined behaviour and meaning Known identity / location Smallest unit of transaction “of interest” to healthcare
V2: Sort of like Segments V3: Sort of like CMETs
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What is/isn’t a Resource?
Examples
Administrative Patient, Location,
Encounter, Organization, Clinical Concepts
AllergyIntolerance, Questionnaire, Observation
Infrastructure Document, Message,
Profile, Conformance
Non-examples
Gender Too small
Blood Pressure Too specific
Pregnancy Too broad
Electronic Health Record Too big
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Resource
Narrative
Elements
ExtensionsExtensions
Structure of a Resource
Metadata
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Structure of a Resource(XML example)
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Human Readable
CDA taught HL7 a very important lesson Even if the computers don’t understand 99% of
what you’re sending, that’s ok if they can properly render it to a human clinician
This doesn’t just hold for documents – important for messages, services, etc.
In FHIR, every resource is required to have a human-readable expression Can be direct rendering or human entered
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Resources in the spec
Let’s take a look at some Resources in the specification….
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Composition vs. reference
FHIR makes composition and references explicit: References are in between Resources. No
context conduction across references – safe retrieval as individual resources.
Composition is within a Resource: Components have no meaning outside resource, no identity, no separate access path except through resource
© 2012 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Composition of a Resource
Resource Root
Resource Component
Simple & Complex elements (may be repeating)
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Composition
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Resource Reference
“Refers to…”
Note: No referential integrity – references are just URL’s
DiagnosticReport
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Resource Reference
Example: part of DiagnosticReport
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Network
subject
performer
organization
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Not a hierarchy!
Patient
Episode Episode
VisitVisit
Observation Order
Not an “electronic” version of a patient file…
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Resource Aggregate
“How do we know where an object made up of other objects begins and ends?”
“In any system with persistent storageof data, there must be a scope for a transaction that changes data and a way of maintaining the consistency of the data”
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“Business” identifiers
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A Resource’s identity
In fact: an URL
http://server.org/fhir/Patient/1
endpoint
resource type
identifier
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Patient
MRN 22234“Ewout Kramer”30-11-1972Amsterdam
Resource metadata
Metadata
Resource Identitieshttp://fhir.hl7.org/Patient/23E455A3Bhttp://fhir.hl7.org/Patient/23E455A3B/_history/4
Last updated2013-12-23T23:33:01+01:00
http://hl7.org/fhir/tag/profilehttp://hl7.org/fhir/Profile/us-core
http://hl7.org/fhir/taghttp://example.org/fhir/Status#Test
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REST SERVICE INTERFACEHow FHIR uses RESTful principles to communicate Resources
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Paradigms
FHIR supports 4 interoperability paradigms
REST Documents
Messages Services
REST
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The Glory of REST
Source: http://martinfowler.com/articles/richardsonMaturityModel.html
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REST?
“REpresentational State Transfer” Represent your data as “resources” Make “Resources” URI addressable Use HTTP to do CRUD operations Resources may be exchanged using
different representations
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Just a quick GET
GET /fhir/patient/1 HTTP/1.1
HTTP/1.1 200 OKContent-Type: application/xml+fhir;charset=utf-8Content-Length: 787Content-Location: http://spark.furore.com/fhir/Patient/1/_history/12Last-Modified: Tue, 29 May 2012 23:45:32 GMT
<?xml version="1.0" encoding="UTF-8"?><Patient xmlns="http://hl7.org/fhir"><identifier><label>SSN</label><identifier><system>http://hl7.org/fhir/sid/usssn</system><id>444222222</id></identifier></identifier><name><use>official</use><family>Everywoman</family><given>Eve</given></name><telecom><system>phone</system><value>555-555 2003</value><use>work</use></telecom><gender><system>http://hl7.org/fhir/sid/v2-0001</system><code>F</code></gender><birthDate>1973-05-31</birthDate><address><use>home</use><line>2222 Home Street</line></address><text><status>generated</status><div xmlns="http://www.w3.org/1999/xhtml">Everywoman, Eve. SSN:444222222</div></text></Patient>
UTF-8 encoded
See the BOM?
HTTP Verb + path
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A Resource’s REST identity
In fact: an URL
http://server.org/fhir/Patient/1
endpoint
resource type
identifier
Note: This URL resolves to the current version of a resource
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REST “representations”
GET /fhir/Patient/1?_format=json HTTP/1.1
HTTP/1.1 200 OKContent-Type: application/json+fhir;charset=utf-8Content-Length: 787
GET /fhir/Patient/1 HTTP/1.1
Accept: application/json+fhir
HTTP/1.1 200 OKContent-Type: application/json+fhir;charset=utf-8Content-Length: 787
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Patient
MRN 22234“Ewout Kramer”30-11-1972Amsterdam
Remember metadata?
Metadata
Resource Identitieshttp://fhir.hl7.org/Patient/23E455A3Bhttp://fhir.hl7.org/Patient/23E455A3B/_history/4
Last updated2013-12-23T23:33:01+01:00
http://hl7.org/fhir/tag/profilehttp://hl7.org/fhir/Profile/us-core
http://hl7.org/fhir/taghttp://example.org/fhir/Status#Test
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Mapping (meta)data to HTTP
Resource data Resource id Resource version
Last update date Tags
http body Url Content-Location
header Last-Modified header Category header
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Tag metadata
GET /fhir/Patient/1 HTTP/1.1
HTTP/1.1 200 OKContent-Location: http://server.com/fhir/Patient/1/_history/12Last-Modified: Tue, 29 May 2012 23:45:32 GMTCategory: http://example.org/fhir/Status#Test; scheme="http://hl7.org/fhir/tag"; label="Our test tag"
http://hl7.org/fhir/tag A general tag
http://hl7.org/fhir/tag/profileA profile tag - a claim that the Resource conforms to the profile identified in the term
http://hl7.org/fhir/tag/security A security label
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REST in the spec
Let’s look at these operations in the specification….
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Mapping to verbs
create 2.1.10 The create interaction creates a new resource in a server assigned location. The create interaction is performed by an HTTP POST operation as shown:
POST [service-url]/[resourcetype] (?_format=mimeType)
read 2.1.6 The read interaction accesses the current contents of a resource. The interaction is performed by an HTTP GET operation as shown:
GET [service-url]/[resourcetype]/{id} (?_format=mimeType)
update 2.1.8 The update interaction creates a new current version for an existing resource or creates a new resource if no resource already exists for the given id. The update interaction is performed by an HTTP PUT operation as shown:
PUT [service-url]/[resourcetype]/{id} (?_format=mimeType)
delete 2.1.9 The delete interaction removes an existing resource. The interaction is performed by an HTTP DELETE operation as shown:
DELETE [service-url]/[resourcetype]/{id}
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Exercise #1
Fiddling around with Fiddler&
Getting data from a FHIR test server
(45 minutes)
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Break!
Coffeebreak
15 minutes
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DECONSTRUCTING THE FHIR DATAMODEL
The basic building blocks of FHIR
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Let’s look at datatypes
Resource
Narrative
Extensions
Metadata
Elements
ExtensionsPrimitives(integer, boolean, string, instant)
Derived Primitives
(oid, uuid, code, id)
CompositeDatatypes(HumanName, Quantity, Period,Address, Identifier )
Constrained Types
(Quantity: Distance, Count, Duration, Money)
use
use
use
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Primitives - peculiarities
boolean xs:boolean Values can be either true or falseinteger xs:int A signed 32-bit integer
decimal xs:decimal A rational number. A true decimal, with inbuilt precision (e.g. Java BigDecimal)
instant xs:dateTimeAn instant in time - known at least to the second and always includes a timezone.
uri xs:anyURI A Uniform Resource Identifier Reference.
dateunion of xs:date, xs:gYearMonth, xs:gYear
A date, or partial date as used in human communication. No time zone.
dateTime
union of xs:dateTime, xs:date, xs:gYearMonth, xs:gYear
A date, date-time or partial date as used in human communication. If hours and minutes are specified, a time zone must be populated.
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Derived primitives
Using the ISO date/time with timezone “1951”, “1951-06” and “1951-06-04” “1951-06-04T10:57:34.0321+01” “1951-06-04T10:57:34.0321Z”
Derived types based on uri(!): OID and UUID urn:oid:1.2.3.4.5 urn:uuid:a5afddf4-e880-459b-876e-e4591b0acc11
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Level up: Composite Datatypes
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Datatypes
Let’s take a look at the “Data Types” section of the FHIR specification at
http://www.hl7.org/implement/standards/fhir/datatypes.htm
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Coded types
Codes are defined in code systems
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Coded types
When used in a Resource, the modelers include Bindings
Bindings specify which codes can be used
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Level up: resources
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“Choice” properties
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References
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Quick look at extensions
Resource
Narrative
Extensions
Metadata
Elements
Extensions
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Extending a multiple birth
Key = location of formal definition
Value = value according to definition
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Complex extensions
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Quick look at narrative
Resource
Narrative
Extensions
Metadata
Elements
Extensions
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Narrative
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Exercise #2
Editing a Resource Instance -by hand!
(45 minutes)
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Using VS / Eclipse
Eclipse: You need the Xml editing tools and add<Patient xmlns="http://hl7.org/fhir" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://hl7.org/fhir ../patient.xsd">
VisualStudio: Go to Xml/Schemas… then add fhir-all.xsd
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Break!
Lunch
60 minutes